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Kansas Summer 2019CommunityConnectionsFor More InformationCall our Provider Services Center at 877-542-9235Visit UHCprovider.com
Important information for health care professionals and facilitiesIn This Issue Our New Clinical Medical Director A Brief Overview of Measles Non-Participating Provider Change Provider Enrollment Managed Care Regulation Implementation Update UnitedHealthcare Dual Complete Rewards Offeredto Members to Support Preventive Care Reporting Health Care Fraud, Waste and Abusep.1Home- and Community-Based Services News New Corrected Claim Functionality in claimsLink for Professional Claims Prior Authorization Requirements for Kansas Medicaid New “Provider Only” Function Search Option in claimsLinkWe hope you enjoy the summer edition of Community Connections. In this issue,you can read about our new clinical medical director, an overview of measles,PreCheck MyScript, and much more.Community Connections: KS – Summer 2019Provider Services Center: 877-542-9235
Important information for health care professionals and facilitiesOur New Clinical Medical DirectorWe’re pleased to welcome our new Clinical Medical Director Dr. Charles Davis.Dr. Davis brings over 15 years of experience in the medical field to United HealthGroup. Board-certified in internal and geriatric medicine, he received his trainingat the University of Kansas, wherehe completed an internal medicine residency and a geriatric medicine fellowship.In 2004, after completing these programs, Dr. Davis opened a private practice,Heartland Geriatrics, to serve patients and families in the bi-state, metropolitancommunity. Heartland Geriatrics grew to a substantial practice — with severalnurse practitioners and staff under — and his team took care of patients in over 30nursing homes, assisted living facilities, and rehabilitation centers all over KansasCity. He also holds certification in medical direction and served as the medicaldirector for a number of facilities in the Kansas City and surrounding area.We’re excited to have Dr. Davis join us at UnitedHealthcare Community Planof Kansas.11CommunityConnections:KS –2013Summer 2019Practice Matters:TX - SummerProvider ServicesCustomerService Center: 877-542-9235888-362-3368
Important information for health care professionals and facilitiesA Brief Overview of MeaslesDr. Charles DavisClinical Medical DirectorAs care providers, you’re aware of the dramatic increasein the number of measles cases being reported in thenews almost daily. Because this disease has been nearlynonexistent in the United States for many years, mostof us have not seen a case of the measles. We want toremind you of some pertinent facts about this disease.The live measles vaccine was licensed for use in 1963.Prior to the development of the vaccine, approximately550,000 measles cases and 495 measles deaths werereported annually in the United States; most cases werenot reported. Of those cases reported, about 50,000people were hospitalized. Annually, approximately 1,000of the measles cases developed chronic disability fromacute encephalitis, which often resulted in permanentbrain damage.In the year 2000, measles was declared eliminated in theUnited States. Since that time, the number of cases hasranged from 37 in 2004 to 667 in 2014. Currently, fromJanuary 2019 to May 2019, 839 cases of measles havebeen confirmed in the United States. The recent increaseis due to the increased number of travelers who getmeasles abroad and bring it into the country, spreadinginto communities with pockets of unvaccinated people.The measles virus is a single stranded, enveloped RNAvirus with one serotype. It is classified as a member ofthe genus Morbillivirus within the family Paramyxoviridae;humans are its only host. It’s transmitted by directcontact with infectious droplets or airborne particlesvia sneezing, cough, or breathing. The measles viruscan remain infectious in the air for up to two hoursafter the infected person leaves an area. Measles is ahighly contagious virus infecting the throat and mucousmembranes with common complications of otitis media,bronchopneumonia, laryngotracheobronchitis anddiarrhea. People at high risk of complications and severeillness from measles include infants and children lessthan age 5, adults older than age 20, pregnant womenand people with compromised immune systems.The clinical features of measles include a prodromeof fever, malaise, cough, coryza and conjunctivitis —the three “C”s — and Koplic’s spots (pathognomonic),which may occur inside the cheeks. This is followed bya maculopapular rash that spreads from the head to thetrunk to the lower extremities — including the palms ofthe hands and soles of the feet. The rash usually appearsabout 14 days after a person is exposed to an infectedperson. Patients are considered to be contagious fromfour days before to four days after the rash appears.Notably, immunocompromised patients might not developa rash.As mentioned earlier, the initiation of a robust MMRvaccination program led to the measles being declaredeliminated in 2000. The Advisory Committee onImmunization Practices (ACIP) recommends that peoplewithout evidence of immunity to measles be vaccinated.Acceptable presumptive evidence of immunity includes:1. Written documentation of adequate vaccination,which includes:–– One or more doses of measles-containing vaccineadministered on or after the first birthday forpreschool-age children and adults not at high risk.–– Two doses of measles-containing vaccinefor school-age children and adults at highrisk, including college students, health careprofessionals and international travelers.2. Laboratory evidence of immunity.3. Laboratory confirmation of measles.4. Birth before 1957.As a health care worker, exposure to the measles is anoccupational risk. Post-exposure prophylaxis with immuneglobulin (IgG) administered within six days prevent ormodify measles in persons who are nonimmune. It is notindicated for persons who have received one dose ofmeasles-containing vaccine at age 12 months or olderunless they are severely immunocompromised.(continued on next page)22CommunityConnections:KS –2013Summer 2019Practice Matters:TX - SummerProvider ServicesCustomerService Center: 877-542-9235888-362-3368
Important information for health care professionals and facilities(continued on previous page)There are a number of excellent resources andreferences on the Centers for Disease Control andPrevention (CDC) website. Please refer to the websitefor additional information about measles and b3cdc.gov/vaccines/acipindex.htmlNon-Participating Provider ChangeBeginning with dates of service Oct. 1, 2019 andafter, care providers who are not participating in theUnitedHealthcare Community Plan of Kansas plan arerequired to obtain prior authorization for their claimsto be paid. Emergency services and services that arecovered by another primary payer are excluded from thisrequirement.Provider Enrollment Managed CareRegulation Implementation UpdateAll KanCare managed care organization (MCO) networkproviders who receive payment for KanCare membersare required to be screened and enrolled in the KansasMedical Assistance Program (KMAP). Care providersshould have enrolled with KMAP by July 1, 2019. Failureto do so will result in claim denials.Synchronization and use of the following data elementsacross the MCOs and KMAP is critical to accurate claimsprocessing: NPI Provider nameTo enroll with KMAP, access the ProviderEnrollment Wizard at kmap-state-ks.us/Public/Provider.asp. The Kansas modular MedicaidSystem (KMMS) Provider Enrollment Wizard isavailable for use. See KMAP Bulletin #18261.Until further notice, all provider record changes must bereported to KMAP instead of UnitedHealthcare. Careproviders can contact KMAP at 800-933-6593 with anyadditional questions on their current status with KMAP.See Provider Enrollment Bulletins for all the details.General Bulletin #18183, #18180, #18218, #18223 and#18131 are available online at sp.UnitedHealthcare Dual Complete Rewards Offered to Members toSupport Preventive CareThe Dual Complete Rewards program is included at nocost as part of all UnitedHealthcare Dual Complete Plans.This program helps members earn rewards for taking careof their health. Simple tasks such as having a checkupor getting a flu shot may be rewarded. All members haveto do is provide a few details and they earn valuable giftcards by mail or online. The more activities they complete,the more gift cards they can earn.Connect eligible members into the UnitedHealthcareDual Complete Rewards program today to further supportpreventative care for improved health outcomes.There are two easy ways members can activate theiraccount and claim rewards: Online at UHCDualRewards.com Phone: 866-551-0987, TTY 711,7 a.m. – 9 p.m.Central Time, Monday-Friday 9 a.m. – 2 p.m. Central Time, Saturday Provider types and specialties/services Taxonomy Tax ID number33CommunityConnections:KS –2013Summer 2019Practice Matters:TX - SummerProvider ServicesCustomerService Center: 877-542-9235888-362-3368
Important information for health care professionals and facilitiesReporting Health Care Fraud,Waste and AbuseIt’s the responsibility of all of us to report health carefraud, waste and abuse.Fraud – Intentionally misrepresenting or concealing factscommitted by a person or entity that could result in aninappropriate gain or benefit.Waste – Inaccurate payments for services, such asunintentional duplicate payments, and inappropriateutilization and/or inefficient use of resources.Abuse – Provider practices that are not medicallynecessary or that fail to meet professionally recognizedstandards for health care.If you suspect any fraud, waste or abuse, callUnitedHealthcare Community Plan ProviderServices at 877-542-9238 or call Kansas FraudControl at 866-551-6328 or 785-368-6220.Report any situation that is suspicious. Reportingcan remain anonymous. Let’s help protect ourcommunity together.Home- and Community-BasedServices (HCBS) NewsNew Corrected Claim Functionalityin claimsLink for ProfessionalClaimsAs of April 1, 2019, the new professional corrected claimfunctionality is available. This allows care providers tosubmit corrected professional claims (CMS1500) online.For more information, visit aims-QRG.pdf.44CommunityConnections:KS –2013Summer 2019Practice Matters:TX - SummerPrior Authorization Requirementsfor Kansas MedicaidVisit Link to review the updated prior authorizationrequirements that became effective April 1, -AuthorizationEffective-04012019.pdf.New “Provider Only” FunctionSearch Option in claimsLinkThe “Provider Only” search option is now available in theclaimsLink tool, in addition to our recently added ClaimNumber and Patient Account Number search options.This new search still allows users to search by TIN anddate of service for all paid and denied claims. But it alsoallows users to search at the individual care providerlevel by a date of service in a set or custom date rangeand returns acknowledged, pending, payable, paid anddenied claims.For more information, visit laims/claimsLink-Claim-Status-QRG.pdf.Provider ServicesCustomerService Center: 877-542-9235888-362-3368
KansasCommunityConnectionsCommunity Connections is a quartly publication for physicians and otherhealth care professionals and facilities in the UnitedHealthcare network.Community PlanDoc#: PCA-1-016061-05312019 07302019 2019 UnitedHealth Group, Inc. All Rights Reserved.10895 GrandviewSuite 200Overland Park, KS 66210
To enroll with KMAP, access the Provider Enrollment Wizard at kmap-state-ks.us/Public/ Provider.asp. The Kansas modular Medicaid System (KMMS) Provider Enrollment Wizard is available for use. See KMAP Bulletin #18261. Until further notice, all provider record changes must be reported t
